MASSIVE HEPATOSPLENOMEGALY, JAUNDICE AND PANCYTOPENIA IN MILIARY TUBERCULOSIS

A 29-year-old Caucasian woman presented to hospital with a 2-day histo ry of diarrhoea, anorexia and rigors, investigations showed abnormal l iver function tests, hyponatremia, hypoalbuminaemia and lymphopenia. T he initial chest radiograph was normal, a bane marrow trephine biopsy showed non-caseating granulomata and she subsequently developed miliar y shadowing on the chest radiograph. A transjugular liver biopsy confi rmed the presence of acid-alcohol fast bacilli, Despite starting tripl e therapy for miliary tuberculosis she remained febrile and developed massive hepatosplenomegaly, jaundice and pancytopenia, Standard triple therapy was substituted with ethambutol, streptomycin and oral predni solone and the patient made a dramatic recovery, The clinical symptoms of miliary tuberculosis are frequently non-specific and the onset of the illness is often insidious, The liver is involved in almost all pa tients with miliary tuberculosis, but massive hepatosplenomegaly and j aundice are rare, Standard triple-therapy should be discontinued when there is significant liver dysfunction, and corticosteroids should be considered for patients with miliary tuberculosis who fail to respond to conventional therapy.